Procedure
Before the actual laparoscopy can start, the patient must be instructed by the respective doctors (anaesthetists, surgeon). Since the operation is performed under general anaesthesia, blood-thinning medication such as aspirin or Marcumar must be discontinued, otherwise there may be unintentional massive bleeding during the operation. In the case of laparoscopy, one must then create an access to the abdominal cavity.
To do this, the abdominal wall, which consists of muscles, skin and fatty tissue, must be punctured. The hole must be large enough for all instruments and the camera to fit through the opening. The doctor uses a kind of thick needle which he pierces through the abdominal wall.
To pierce as thin a part of the abdominal wall as possible, the doctor usually chooses a point below the navel. However, it may also be that because of organs that may be in the way (for example, if the intestine has slid down too far), the puncture site must be chosen at a different location. The principle is always the same for a laparoscopy, no matter which organ is to be examined or removed.
First of all, the doctor must “inflate” the patient’s abdominal cavity to obtain a better overview. CO2 is chosen for this purpose, as it is absorbed through the abdomen and can then be easily breathed out through the lungs without causing allergic reactions or the like. In the end you have an inflated abdomen, which from the outside looks a bit like the patient is 9 months pregnant.
As the abdominal wall is very elastic and the pressure in the abdominal cavity is constantly controlled, there is no need to be afraid that the abdomen will be inflated too far or even burst. Depending on the size and extent of the patient, the doctor pumps up to 7l CO2 into the abdomen and now has a very good overview of the area to be examined. Now the needle that pierced the abdomen can be replaced by the so-called trocar.
This is a kind of tube through which the various instruments and a small camera for orientation, the laparoscope, can be inserted. With the help of this abdominal mirror, the doctor can now get an overview of the stomach, liver, spleen, intestine and especially the (female) sexual organs and detect any changes. Laparoscopy is frequently used, especially in gynaecology.
In order for the doctor to be able to look primarily at the female sexual organs without these being covered by the intestines, the patient is tilted backwards on the couch so that her head hangs down. This also causes the complete organs of the gastrointestinal tract to slide down and the doctor has a perfect overview of the female genitals of interest to him. In gynaecology, laparoscopy is particularly popular because it is very efficient for both diagnosis and therapy without any cosmetic disadvantages.
Laparoscopy is used, for example, in cases of unwanted childlessness. With the help of laparoscopy, samples can be taken from the patient or contrast medium can be injected into the ovaries to determine whether the fallopian tubes are continuous. By inserting the contrast medium into the fallopian tubes, a magnetic resonance tomograph (MRT) or computer tomograph (CT) can be used to determine whether the fallopian tube is completely open and is therefore able to transport the egg into the uterus so that a baby can grow there.
Particularly in women who wish to have children and have already been diagnosed with an ectopic pregnancy, laparoscopy can provide information about their fallopian tubes and thus their ability to bear children. However, laparoscopy can not only test the permeability of the fallopian tubes but also cut them (sterilisation) if the woman no longer wishes to have children. In addition, ectopic pregnancies can be removed by laparoscopy.
Even in the case of chronic abdominal pain, the doctor can choose laparoscopy as a last diagnostic option if previous examinations such as palpation and ultrasound have not revealed anything. Here, for example, endometriosis can be diagnosed by means of laparoscopy, which can lead to severe abdominal pain and bleeding. If endometriosis is suspected, a laparoscopy is often used to confirm the diagnosis.
Endometriosis is a benign dislocation of uterine tissue into other parts of the body, such as the intestines. This is not serious in itself, but as already mentioned, it can lead to chronic abdominal pain and in addition to spotting, i.e. bleeding that is not caused by normal periods. However, laparoscopy is also used for direct therapy, for example to remove benign tumours in the uterus (myoma).
Laparoscopy is also used to remove cysts from the ovaries. Cysts are also benign, fluid-filled hollow bodies, but they can cause pain and should therefore be removed.
